international health, life in the boonies, family doc stuff… musings from rural Canada

Posted by: sayamika, the killer bunny | 2007 February 27

Out of context

So often I, as a medical student, talk to senior members of staff, consultants, and in slower moments I occasionally ask the dreaded question: “Would you do it again?”

Quite often I get an unequivocal “Yes, absolutely. I love my work; for all the sacrifices, I know I am doing exactly what I should be doing.”

But also often, I get a long pause….

One surgeon, notorious amongst the medical students for being ornery, cranky, a real shouter, is my favourite guy in the hospital. When I told him about my career aspirations, asked me quite seriously if I was insane. Said that if he had his time back, he would have done something else. Then he looked at me sadly and said, “You’ve got the surgery bug.”

I can’t wait to do my clinics with him.

*******

I am avowedly left-wing, socialist, supporter of public health care and not pleased about the recent decision to allow private health cover alongside the public system in Canada due to my (admittedly limited) experiences with the two-tier British system where the weathy buy their way off the waiting lists and the poor languish without the political clout to push the government to DO SOMETHING about the waiting lists.

I am an idealist. A volunteer. I am totally infatuated with the idea of Medecins Sans Frontiers. I don’t think physicians should make half a million dollars a year anywhere in the world.

But I expect that practise will change my mind. I hope I will keep my soft heart, thick skin, and hard head, but reading things like this (from MDOD), written as a pissed-off rant by an ED physician, makes me wonder if I will someday think the same way.

I MIGHT even agree that some basic level of care SHOULD be a basic right for American citizens. It is most certainly not, however, a right for whoever happens to have made a series of poor choices about how to live their lives, or has just arrived in country after climbing some fence or fording some river or hopping-off some boat. The burden of providing this “right” for the above pitiful flotsam and jetsam of humanity right now is placed directly on physicians, insurance companies, and people responsible enough to have jobs, pay taxes, and insure themselves against illness. It’s wrong. It’s not American. It is a recipe for disaster.

As far as I can see it, yes, there are time wasters out there who are too lazy to work, but they are the minority. Most people on that situation want to work and can’t for some reason or another, or, they do have a job (or three) but it doesn’t stretch to paying the rent, feeding the kids AND paying for health insurance.

Poor choices do happen. Kids get pregnant (by accident or to escape a bad home situation or to feel loved or just because they’re stupid). Kids drop out of school (because they have learning difficulties or because they’re bullied or just because they’re stupid). I could go on and on.

The upshot of all this is that it’s easy to be critical when you were born with a silver spoon in your mouth, but some of us know what it takes to claw up out of a bad family situation, out of systemic poverty, into something where you can become a responsible tax-paying citizen. It’s not easy, and people who are trying to do so don’t need a foot on their neck, they need the occasional benefit of the doubt. Particularly where it comes to outrageously-priced healthcare.
And if a few of the time wasters take advantage, isn’t it worth it if a few people who are really working hard get a break?

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“And if a few of the time wasters take advantage, isn’t it worth it if a few people who are really working hard get a break?”

There’s a difference between me choosing to volunteer, donate, provide pro bono services, etc, and me being forced to do it by the government. It’s a big difference. I don’t think I would keep practicing medicine in the US if a single-payer system was instituted here, that’s how much I hate and fear government involvement in yet another area that ought to belong to private decisions; but until then, I plan to work in underserved areas, volunteer in free clinics, and see a certain number of uninsured patients without charge in my office.

I’d like to hear more about this anatomy course. I haven’t heard of anything like that before starting surgery internships in the US.

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